Is Brown Qld Health's white knight?

By: Suzanne Tindal

CIO profile Ray Brown stepped in two weeks ago as the latest chief information officer for Queensland Health, hoping to bring some stability to a division that has seen a number of faces move through the head technology spot in quick succession.

Ray Brown
(Credit: Queensland Health)

The health department's technology leadership game of musical chairs started in July last year when Paul Summergreene, who had moved over to health in the closing months of 2007 from his CIO position at the state's Department of Transport, left after less than a year in the chief information officer job.

His contract had been terminated, Queensland's Health informed the press at the time. There had been reports that his expenses were being examined, but the department wouldn't comment on the issue.

His position was filled briefly in an acting capacity by the clinically adept Dr Richard Ashby. Ashby had served in several hospitals in emergency medicine and medical administration roles. The Australian Medical Association was pleased of the appointment because of Ashby's clinical experience.

"We have seen millions of dollars in health IT funding wasted over the years in Queensland, so the appointment of a highly regarded senior hospital clinician who is acutely aware of exactly what is required to provide optimal patient outcomes is very welcome," it said at the time.

Yet Ashby didn't remain long, leaving in January to become the executive director and director of medical services at Princess Alexandra Hospital.

A bit of stability in the leadership of the division for the next little while would be a good outcome for the division, so that's what I hope occurs.

Ray Brown

Queensland Health again had to fill the void with an interim appointment, reaching into the ranks of its information division. Brown had been acting as the executive director ICT service delivery since June 2008, before which he had been pursuing an IT career in the Queensland public service, holding senior roles in the Police, Corrective Services and the former Department of Families.

Queensland Health may have hit the jackpot this time. Brown hasn't followed the pattern of leaving after only a brief stint on the job. Instead, he was appointed formally to the chief information officer position last week.

And despite much attention being directed at the leadership turmoil, the CIO doesn't believe that it has damaged the long-term technology strategy of Queensland Health.

Since 2006, the IT gurus of Queensland Health have had a mission: to bring the state's hospitals into the modern world of state of the art clinical information systems. Summergreene's predecessor Sabrina Walsh had primed the way by obtaining funding of upwards of $650 million over four years for e-health initiatives.

Whichever leader was in the hot spot, the e-health holy grail was never out of sight, according to Brown. "The e-Health strategy has stood the test of time and remained sound. Each incumbent of the Queensland Health CIO role has built on the direction and progress of the e-Health Strategy without the need to re-visit significant elements of the strategy or the project artefacts delivered," he tells ZDNet.com.au in an interview last week.

When the CIO started in the role in the acting capacity, it had been his focus and it would continue to be so for the next few years, he says.

Around 20 per cent ($243 million) of the funding first made available in the 2007/2008 financial year had been spent, Brown says. The remaining 80 per cent would be spent by 2011/2012.

So far one of the standout successes has been getting an enterprise discharge summary system up and running, a national first, Brown says. The system sees hospital reports go out to GPs who can use them to service outpatients. Brown says, 55,000 summaries have already gone out from 56 hospitals, with June next year seeing 120 facilities being capable of issuing the summaries.

The e-Health strategy has stood the test of time and remained sound.

Ray Brown

Another win has been getting a new imaging system coming online so that diagnostic images taken in rural locations could be examined and used to diagnose remotely.

Brown is also proud of a statewide mental health system which can now be accessed by all mental health workers. Queensland is the first state to set up such a system, according to Brown.

Looking ahead, of course, the "big ticket item" will be setting up an electronic medical record for Queenslanders. Brown says that Queensland was on track to meet the timeline recommendations made by the National Health and Hospitals Reform Commission, which suggested every Australian should have an electronic medical record by 2012.

"Generally speaking we're pretty comfortable that where we're at today will allow us to actually achieve most of those time frames that are in that report," Brown says.

Yet Queensland Health's outlook doesn't look as rosy as some, having had a later start than some states on creating the records. "At some level I think we're behind some of the other states," Brown admits. He points out that NSW and Victoria had done more work in that area. He stresses, however, that Queensland Health was ahead in other areas, and could catch up on the systems in which it was lagging.

"The forward work program and the way this organisation is structured is probably going to allow us to certainly catch up if not pass some of those other jurisdictions in terms of their e-health agenda," he says.

However, he can't forget that e-health is only good as long as the systems are reliable. Earlier this year one of Queensland Health's datacentres had a train of small problems which lead to some applications going off line.

Brown acknowledges that datacentres are on the agenda at the moment. "We will be migrating all of our production environments over the next four to five years to the new government datacentres that are being established," he said. Those new datacentres, like the Polaris datacentre in Springfield, have at least a tier three rating.

At some level I think we're behind some of the other states.

Ray Brown

There isn't really a planned time for migration, according to Brown. As the department refreshes equipment, the new equipment will be set up in new datacentres instead of in the current ones. The electronic medical record will be established straightaway in a new datacentre.

Along with updating datacentre facilities, Brown will also be looking to make hospitals wireless as the electronic health agenda comes online. The department has recently been doing trials with Cisco to gauge how mobile devices can benefit the health environment.

The results have been positive. Yet in order for mobile devices to have the required affect, older hospitals need to be networked. With only $60 million budgeted this year for all IT infrastructure, this could require an additional line of funding. "That won't cover wireless for the state, that's for sure," Brown says.

This is unlikely to be the only roadblock to Brown's goals in what will be a challenging period of e-health implementation. Yet, most importantly for Queensland Health, Brown at least looks set to remain for a time yet. This will likely bring a little more stability to the department which has seen CIOs pass through too quickly.

"A bit of stability in the leadership of the division for the next little while would be a good outcome for the division, so that's what I hope occurs," he says. And, as mentioned before, he believes in the e-health chalice he has been handed, which could be half the battle.

Patients may have to foot e-health bill

By: Karen Dearne

PATIENTS may have to pay for their own electronic health records, with the key healthcare reform body urging the federal Government to mandate "person-controlled" systems commercially available from providers like Microsoft and Google.
"We believe that the rapid development of new IT applications required across the health sector to give people the opportunity to have an electronic health record is best undertaken by commercial IT developers in an open competitive market," the National Health and Hospitals Reform Commission (NHHRC) said in a supplementary paper released today. While tech-savvy patients are increasingly keen to manage their own medical records, public agencies worldwide have opted to maintain control over health information-sharing systems to ensure confidentiality, technical security and data quality. But in an unexpected turnaround, the NHHRC said "every Australian should be able to choose where and how their personal e-health record will be stored, backed-up and retrieved", and that the record should be "at all times owned and controlled by that person". Instead of providing a national health IT infrastructure, the Government's role should be "to regulate privacy and technical standards", and allow the market to come up with products that suit both consumers and healthcare providers "By 2012, every Australian should be able to have a personal e-health record," said NHHRC chair Christine Bennett. "The Government must legislate to ensure the privacy of a person's e-health data, while enabling secure access to the data by the person's authorised health providers." To thwart likely objections from doctors over sharing information contained in their patients' records, the NHHRC wants the payment of public and private benefits to health and aged care services "to be dependent upon the provision of data to patients, their authorised carers and other health providers, in a format that can be integrated into a personal e-health record". Microsoft has previously told the NHHRC it was feasible to establish an affordable, consumer-controlled e-health record nationwide within one year. Its HealthVault web-based platform has been designed to allow people to collect, store and share their own medical information with doctors and family members. The commission's interim blueprint, released late last year, has been criticised for its failure to put information technologies at the heart of planned health sector reform. While today's paper said the nationwide adoption of individual e-health records would return between $7-$9 billion in economic benefits from increased productivity and reduced adverse events over 10 years, the federal and state governments have baulked at providing the necessary funding. But the NHHRC believes there is no need to finance patients for the creation and maintenance of their own e-health records. Instead, it calls for public funding for "an appropriate social marketing strategy" to inform consumers and health professionals about the significant benefits and safeguards of the proposed new approach to e-health. It also calls for significant funding and resources to help doctors move to the new arrangements. "Engaging private and public healthcare providers to invest in IT systems and infrastructure, change work practices and participate in personal e-health records will be critical to success," the NHHRC said. "Vendors must ensure their systems are compliant with national standards and can receive and send data with patient consent and appropriate authentication." AushealthIT blogger David More warned that the NHHRC approach was "unbalanced" as it over-emphasised the role of the personally held record "and fails to recognise the importance of the provider's records". "In my view, the person's own record needs to be adjunctive to the records, and systems, used by each health professional to optimise the care they deliver," Dr More said. "The care provider needs information of known provenance and trustworthiness from external sources such as referring doctors and labs. "As well, the benefits case for health IT rests on clinical decision support provided at the point of care, and that is not recognised clearly enough in this approach."

Roxon lost on e-health, opposition claims

By: Suzanne Tindal

The Federal Government's lack of a true electronic health agenda had left an opposition offer of bipartisanship on the issue dangling useless by the wayside, Shadow Health Minister Peter Dutton said yesterday.
"[Health and Aging Minister] Nicola Roxon and I don't always have a perfect made in heaven relationship, but nonetheless, when I first sat down with Nicola coming into this portfolio only six months ago I gave her an undertaking that we would — on the issue of e-health — provide bipartisan support," Dutton said speaking yesterday at the Annual Health Congress in Sydney.
We've seen no evidence of an agenda which we can support as we go forward.
The upfront expense and long lead times of e-health solutions meant that the benefits wouldn't be delivered for what was politically, a long time, according to Dutton.
Yet the offer was not being used, the shadow minister said: "I offered that bipartisanship from day one. The offer stands today, and we've seen no evidence of an agenda which we can support as we go forward."
His comments echoed those made by Booz and Company principal Klaus Boehncke at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.
"What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions of e-health programs," Boehncke said.
The lack of drive and vision has seen talent go overseas to where the fruits of its labour might be implemented, he said. "[There are] disillusioned Australians from the National E-health Transition Authority and from Queensland Health and from a lot of healthcare areas, working hard to make sure that Singaporeans get an electronic health record next year."
What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions.
In order to move from this point, Boehncke highlighted three areas he thought needed urgent attention, the first being a national e-health investment strategy which was "much more than a business case" since it defined what would be built, for whom and why. NEHTA currently has a business case for a national e-health strategy, which needs to go before the Council of Australian Governments before funding can be allocated to it.
The second was a national infrastructure and definitions around how data would be shared, where it would reside and who owned the data. Where the data resided would go into consultation after the business plan was approved, according to NEHTA CEO Peter Fleming, speaking at an IIR conference last week.
"At this stage the current thinking is that we will not have one central electronic health record that everyone's part of. The expectation is that there will be multiple electronic health records around the country and that those health records will be provided by various players. In some cases it may be health insurers, in some cases it may be Google or Microsoft, it may be professional bodies," he said.
"Where I think we will end up is that we will have a large indexing service not dissimilar to the type of web technologies we know today that knows where an individual's records are stored and can pull that data back as required. Given the current physical restraints, I think that index will also contain some summary data, things that might be required in an emergency.
The last issue Boehncke outlined was the national health identifier, which he spoke on in expanded fashion since it touched upon prior work of his with the past government's controversial Access Card. "[NEHTA is] developing a number for every Australian. But having a number isn't the same as developing an identifier," he said. Boehncke said it was necessary to have that number linked to the physical person, for example, by using a card, but when he asked people in Australia how they thought the person would be linked to their number, he received a lot of different answers.
This type of stuff really makes the things that were stored on the Access Card seem insignificant.
"I get high-ranking state health ministry officials that tell me people in Australia don't need to be identified securely because they trust their GP... The GP will identify the patient," he said. "Other people tell you oh no, no, no, there'll be a new Medicare card. It'll be a smart Medicare card."
Those people thought it would be easy to upgrade the Medicare card to take on new duties, but it wouldn't be, according to Boehncke.
"Let me tell you, from my Access Card experience I know that's not going to be easy because you're moving from a payment card to what becomes an identity card. And you'll have all these questions like we had with the Access Card. Like can you put a photo on it."
When someone asked if the government was dithering because it was frightened of opening up an Access Card type can of worms, Boehncke said that an e-health card would be much more frightening than the previous government's controversial card because of the type of data it would have stored on it.
"This type of stuff really makes the things that were stored on the Access Card seem insignificant because your health data holds a lot more information about you," he said. "To be afraid of an Australia Card when you are trying to identify people in the health setting might be natural when you look at the Australian history in a lot of these debates," he said.
Yet he believed people would voluntarily take up an e-health card because unlike the Australia Card of the Access Card, an e-health card has a true value proposition — the opportunity to save lives.

Medical histories on internet

By:Anna Caldwell and David Earley

AN alarming privacy breach by one of Queensland's biggest pathology labs has splashed patient medical histories over the internet.

The names, contact numbers and private details of at least 100 patients, and potentially hundreds more, were plastered on the website of Brisbane-based Sullivan Nicolaides.

The breach has cast serious doubt on the safety of electronic patient record systems, and angry patients were last night demanding answers.

The Courier-Mail yesterday viewed 102 patients' details before it alerted the lab to the security breach, which has been blamed on a processing error.

Kay Faulkner from Brisbane was devastated to hear the details of her recently deceased husband were so easily accessible.

"This is disgusting," she said.

"Dishonest people can easily misuse the details of someone who has died so for me this is a serious breach."

Rick and Cindy Gore from north Queensland said the security lapse was "completely unacceptable".

"We were never given a password or website to access so there is no reason for this information to be online - it is not like we could log on and check it ourselves."

The use of electronic records in medicine has jumped as software systems become more sophisticated. But the failure at Sullivan Nicolaides has shown the potential for online records to fall into the wrong hands.

All patients affected by the breach were referred to Sullivan Nicolaides by their GPs for the management of warfarin doses, a blood-thinning drug.

Most were from Queensland and northern NSW, with the files dating back to 2007 and 2006.

The records detail relevant medical history, current medications, as well as patient's next of kin.

Sullivan Nicolaides CEO Michael Harrison initially refused to reveal how many patients records were violated and accused The Courier-Mail of "acting like terrorists".

He later apologised and said 103 files were breached, although The Courier-Mail believes it could be many more.

Mr Harrison said the company had taken the security problem "very seriously", and within an hour of being alerted, the records were removed.

He said patients' details were only meant to have been accessed by authorised doctors and staff.

"Honestly, we are flummoxed (by the breach)," he said.

Despite the violation, Mr Harrison said e-health was the future of medicine. "I don't want this to be adverse publicity for e-heath because electronic health records are crucial to ensuring patients get the right care."

Chair of the Privacy and Security Forum and board director of the Health Informatics Society of Australia Peter Croll said that although private medical records should never be publicly available, there was nothing in the law requiring a breach to be reported.

"Obviously it's totally inappropriate," Mr Croll said.

HealthSmart two years behind schedule

By: Karen Dearne

VICTORIA's troubled $320 million HealthSmart project has failed to get the cornerstone Cerner clinical system working at any of its sites, and has replaced only one of 10 Homer hospital systems, which were obsolete when the program began four years ago.

Auditor General Des Pearson said HealthSmart was at least two years behind schedule and more than half of the budget had been spent with only 24 per cent of the planned installations complete.

In a long-awaited review, Mr Pearson said the original budget, which involved health agency co-funding, was not realistic, and the targets were too ambitious.

Victoria's Human Services Department and the Office of Health Information Systems have consistently deflected concerns raised in the state parliament by vendors, industry observers and even an anonymous group of healthcare workers.

The project judged most at risk, but with the greatest potential benefit, is Cerner's Millennium clinical suite, which includes health records, electronic scheduling, diagnostic services, results reporting, and e-prescribing capabilities.

"The first release of the clinical system has been tested by various user groups and is ready for use, but none of the four lead agencies have committed to using the new system," the report says. "According to the original timelines, the acute hospitals in 10 health agencies should be using clinical systems by now, but even if funding negotiations are concluded shortly, the first four agencies are unlikely to meet the June 2009 completion date."

The $79 million deal with Cerner was signed in March 2006, but costs rose by $17 million to $96 million in 2006 -- the biggest price blowout in the program.

A Cerner spokesman yesterday declined to comment, citing contractual obligations.

Reation suite.

ISoft ran into difficulties supplying systems to the British National Health Service Connecting for Health program, and was subsequently acquired by another Australian firm, IBA Health Group.

Communications director Greg King said IBA Health was "comfortable tracking to the time frames set by HealthSmart" for completion in 2009.

"The procurement process took longer than expected and the project started nine months later than anticipated, so the department, lead agencies and we as vendor are doing quite well catching up," he said.

"We've got nine lead agencies in our portfolio. We already have three live, we have one in implementation and two others are in the planning stage, so we've only got three sites pending."

Mr King said it was "always good to have a third pair of eyes looking at large projects" such as HealthSmart.

"We don't see anything in his report that we have any major disagreement with," he said.

Oracle achieved the best result among technology suppliers, with its E-Business financial management system implemented in eight of 11 participating agencies. The remaining three were due for completion this month.

Mr Pearson found the Oracle project came in $500,000 over the original budget, at $26.8 million.

TrakHealth has set up its standalone Client Management System in two community health centres, and a further 10 sites wish to install the product.

Mr Pearson found there was "room for improvement" in the shared services arena, where underperformance had a knock-on effect on systems availability.

Meanwhile, a lack of interest by agencies in taking up the payroll system might "trigger" payment of a revenue guarantee to the vendor.

Victorian shadow minister for health Helen Shardey said the auditor's findings were not unexpected, but the extent of the project's failure was a surprise.

"We have supported this kind of technology to bring our health system into the 21st century, so the massive failure is a tragedy," she said. "The project has been completely botched, and it points to a government that is just not capable of delivering on these important projects."

Flying doctors spend $2.7m on bush health records

By: Suzanne Tindal

The Royal Flying Doctor Service (RFDS) has entered into a five-year AU$2.7m contract with IBA Health to create a standardised system for its electronic health records.

(Credit: Royal Flying Doctor Service)

The new system will help the Service's health professionals with its 12,000 annual clinical appointments across regional Australia.

Clinicians will be able to remotely access a patient's medical history, including allergies, immunisation records and current medications, via the internet-based system, and update the information during check-ups.

In time, it is hoped the system will also be accessible in aircraft. The RFDS Queensland operations are already using Telstra Next G to achieve this.

Some areas the RFDS visits don't have internet access. For these places, the RFDS will work together with IBA to develop a customised system which will allow "briefcasing" of medical records — taking files that are needed on laptops and synchronising them with the system when the clinician again has an internet connection.

(Credit: Royal Flying Doctor Service)

Ideally, the files will be briefcased from a central location, according to Gary Oldman, RFDS acting national ICT manager, but it depends on the amount of bandwidth required by the application. The Service has a server room in Sydney which could be considered as the central location, however, he said nothing has been finalised.

To have a network on which the system can run, the RFDS has to link together its separate Wide Area Networks. The Service has four areas of operations: South East (NSW, Tasmania, Victoria), Queensland, Central, (South Australia and Northern Territory) and West (Western Australia). The Service has received a draft proposal from Telstra, which is looking to connect the regions via extranet.

The national network will form the backbone for other things, according to Oldman. "Once we've got an infrastructure, we can run other national programs: a national HR system; a national finance system; a national intranet."

The IBA contract includes the licence for the software, implementation, customisation, support and maintenance. Implementation work will start in July and continue to June 2009. Once the new system is in place, the old Service records will be migrated, Oldman said.

(Credit: Royal Flying Doctor Service)

The Service chose IBA Health because it had the bells and whistles but would also speak to other internal and external systems including State hospital, pathology and X-ray records, according to RFDS national health program manager Robert Williams.

"There are various products out there. However, the IBA iSoft product had the most functionality and met NEHTA standards," he said.

NEHTA is responsible for unifying medical records across the nation.